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Impact of Birth Preparedness Education on Skilled Birth Attendance among Pregnant Women in Nigeria

Abstract

Skilled birth attendance is an important component of maternal and newborn health because the presence of a trained and qualified healthcare professional during childbirth can facilitate early recognition and management of complications and improve access to essential obstetric and newborn care. Birth preparedness education provides pregnant women with information and practical guidance on planning for childbirth, identifying a skilled birth attendant, selecting an appropriate place of delivery, arranging transportation, preparing financial resources, obtaining essential birth materials, identifying a support person, recognizing pregnancy and childbirth danger signs, and developing an emergency plan. Skilled birth attendance refers to childbirth assisted by a qualified healthcare professional with the competencies required to manage normal delivery, recognize complications, provide immediate care, and initiate or arrange appropriate referral when necessary. In Nigeria, utilization of skilled birth attendance may be affected by inadequate knowledge, cultural beliefs, financial constraints, transportation difficulties, geographical barriers, limited access to appropriate maternal healthcare facilities, previous childbirth experiences, and misconceptions regarding facility-based delivery. Effective birth preparedness education may improve pregnant women's knowledge, planning, confidence, and willingness to utilize skilled birth attendants during childbirth. Against this background, this study investigates the impact of birth preparedness education on skilled birth attendance among pregnant women in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and the Knowledge-Attitude-Practice framework. The Health Belief Model explains health-related decision-making through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding pregnant women's decisions regarding skilled birth attendance. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, and environmental conditions in shaping maternal health behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how birth preparedness education may improve women's knowledge and attitudes and influence their utilization of skilled birth attendance. Collectively, these theoretical perspectives provide a suitable framework for explaining how birth preparedness education may influence skilled birth attendance among pregnant women in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from pregnant women attending selected public and private antenatal clinics and maternal health programmes in Nigeria using a structured interviewer-administered questionnaire and a skilled birth attendance utilization assessment. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, antenatal clinics, and eligible pregnant women. Where feasible, selected clinics or participant groups will be assigned to intervention and comparison groups. Pregnant women in the intervention group will receive structured birth preparedness education covering identification of a skilled birth attendant, selection of an appropriate place of delivery, transportation planning, financial preparation, essential birth materials, identification of a support person, recognition of pregnancy and childbirth danger signs, emergency planning, and the benefits of skilled facility-based childbirth. Skilled birth attendance will be assessed using indicators such as the type and qualification of the birth attendant, place of delivery, utilization of skilled maternity services, and completion of delivery with an appropriately qualified healthcare professional. Where feasible, self-reported utilization will be verified through available maternal health records or facility documentation. Descriptive statistics will be used to summarize participants' sociodemographic and obstetric characteristics, antenatal care attendance, previous birth preparedness education, birth preparedness status, and skilled birth attendance. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic regression analysis, will be used to determine the impact of birth preparedness education on skilled birth attendance. Where appropriate, skilled birth attendance before and after the intervention will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that birth preparedness education has a significant positive impact on skilled birth attendance among pregnant women in Nigeria. Pregnant women exposed to structured birth preparedness education are expected to demonstrate greater awareness of the benefits of skilled childbirth and increased utilization of qualified healthcare professionals during delivery. Education may improve women's ability to identify appropriate healthcare facilities, arrange transportation, prepare financial resources, and develop plans for accessing skilled care when labour begins or complications arise. It may also strengthen women's recognition of maternal danger signs and encourage timely decisions to seek professional obstetric care. However, education alone may not guarantee skilled birth attendance because women may continue to face barriers such as financial constraints, transportation difficulties, geographical inaccessibility, cultural preferences for non-facility delivery, limited availability of skilled birth attendants, overcrowded healthcare facilities, and concerns about the quality or respectful nature of maternity services. Consequently, birth preparedness education is expected to be most effective when supported by accessible, affordable, respectful, and high-quality maternal healthcare services, reliable transportation and referral systems, and adequate availability of skilled birth attendants. The study is expected to contribute to the literature on birth preparedness, skilled birth attendance, maternal health education, antenatal care, maternal healthcare utilization, childbirth, maternal and newborn health, and public health in Nigeria by providing empirical evidence on the impact of birth preparedness education on skilled birth attendance among pregnant women. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, National Primary Health Care Development Agency, hospitals, primary healthcare centres, antenatal clinics, midwives, nurses, community health workers, maternal health programmes, development partners, and policymakers regarding strategies for increasing the utilization of skilled birth attendance. The study will also provide evidence-based recommendations for integrating birth preparedness education into routine antenatal care, strengthening maternal health counselling, improving transportation and referral systems, increasing availability of skilled birth attendants, addressing cultural and financial barriers to facility-based childbirth, improving the quality and respectful nature of maternity services, and promoting timely utilization of skilled maternal healthcare services in Nigeria.

Keywords: Birth preparedness education, skilled birth attendance, pregnant women, Nigeria, maternal health education, antenatal care, childbirth, facility-based delivery, maternal healthcare utilization, skilled birth attendant, maternal and newborn health, emergency preparedness, reproductive health, public health.